"Cure" for lung cancer: More hype or new hope?

"Historically most patients of lung cancer were smokers with advanced lung disease, advanced cancer, and treatments were not very successful. So there was a high degree of pessimism about lung cancer and lung cancer therapy.

There was no way to diagnose lung cancer early, and most patients presented with metastatic disease which could not be cured thereby further increasing the pessimism about it,” said Dr Paul A Bunn Jr, Distinguished Professor, Division of Medical Oncology, University of Colorado and James Dudley Chair in Lung Cancer Research, USA. Dr. Bunn is also the former President of the International Association for the Study of Lung Cancer (IASLC), former CEO of IASLC, former President of the American Society of Clinical Oncology (ASCO), and the 2016 ASCO David A. Karnofsky Award recipient.

“Recently a number of scientific advances have reduced lung cancer mortality worldwide which is an important feat because lung cancer is the most common cause of cancer deaths in the world – about 1.6 million deaths from lung cancer occur globally every year.” said Dr. Bunn. Countries need to do better in addressing risk factors that are associated with lung cancer; tobacco use and air pollution are two of the major causes of lung cancer.

Early diagnosis of lung cancer is possible

Early diagnosis of lung cancer helps save lives. “For early detection, annual low dose computed tomography (LDCT) scans can reduce lung cancer mortality and they can lead to detection of more stage I patients early on that can be cured. So a lung cancer ‘cure’ is not mere hype, rather it has become a reality! Cure rates can be higher for lung cancer by adoption of LDCT scans for early diagnosis, though there are challenges still – such as the high false-positive rate of these scans. Hopefully, currently ongoing research might improve the accuracy of these scans in the future,” Dr. Bunn said.

Better treatment options give hope

It’s not just early diagnosis of lung cancer that has become a reality now, new treatment options have come up as well in recent years. “There are major improvements in lung cancer treatment. For early stage patients we have VATS (Video Assisted Thoracoscopic Surgery) which is effective, cheaper, and has better outcomes in terms of morbidity and mortality. Another advancement is Stereotactic Body Radiation Therapy (SBRT) which gives radiation only to the cancer tumour site and thus morbidity and mortality due to radiation has also declined,” Dr. Bunn said.

Dr. Bunn then shared more information on new forms of treatment, adding, “Molecular therapies are for patients who have driver genetic mutation – patients receive a pill every day (a form of chemotherapy) which has a much higher response rate, fewer side effects, and much longer duration of response. Molecular therapies have improved outcomes for patients with metastatic lung cancer but unfortunately these therapies do not cure people. Molecular therapies even if not a cure give lung cancer patients way more hope as they make them live longer and better. It is certainly hoped that the combination of different treatments may improve outcomes in future.”

Immunotherapy: A new revolution?

Another new form of treatment that has boosted hope for a cure is immunotherapy. “The first form of immunotherapy that has been approved for lung cancer involves monoclonal antibodies that are directed to proteins called checkpoint inhibitors. Checkpoints are proteins that cancer cells make to protect them from being killed by lymphocytes which are part of our immune system. These monoclonal antibodies block proteins which were protecting cancer cells so that our lymphocytes can kill those cancer cells. Monoclonal antibodies are proteins that have to be given intravenously. The response of immunotherapy with monoclonal antibodies lasts much longer and has far less toxicity,” Dr. Bunn said.

But immunotherapy does not work on all patients of lung cancer because all patients do not have checkpoint inhibitors. “That is why we are trying to find biomarkers to define which patients may respond to immunotherapy. These monoclonal antibodies are very expensive, which makes it even more important to find which patients are more likely to respond. Also, currently scientists are evaluating whether these monoclonal antibodies are more likely to cure advanced stage or early stage patients of lung cancer. Currently, it is likely that these monoclonal antibodies may improve cure rates for early stage patients of lung cancer,” shared Dr. Bunn.

Reverse pessimism and make care affordable

Dr. Bunn strongly advocated for reversing pessimism that has enveloped lung cancer historically. With new advancements in lung cancer diagnostics and therapy, it is important to harness hope and make these latest advancements available in all countries. “Outcomes for patients of lung cancer are much better in 2016 than they were in 2000. So, a lung cancer ‘cure’ is not hype. We need to find ways to make these new expensive diagnostic tools and therapies appropriately delivered in developing countries,” said Dr. Bunn.